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Baby Alumni Club
Application
Baby Alumni Club Application
Anyone born at the Nix Hospital is eligible to become a member of the Nix Baby Alumni Club. Please tell us where to send the Certificate of Membership. Fill in the appropriate information.
Fields marked with red are required to submit the form.
Yes, I was born at the Nix Hospital.
Mr.
Mrs.
Miss
Dr.
*
First Name
*
Maiden Name
*
Last Name
*
Birthdate M/D/Y
(Example: 09/09/50)
*
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E-mail
*
Address
*
City
*
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*
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